Hollow upper eyelid - permanent solution?

Hyaluronic acid filler is the current best most reliable way of addressing this and this is a fussy service that requires maintenance.  Grafted fat causes unrepairable scaring and has never lived up to its promise no matter what you might read on certain websites on the internet.  There is no substitute for a personal consultation from a surgeon who devotes a significant part of their practice to fixing issues.  The presence of upper eyelid ptosis or prior eyelid surgery often sets the stage for better long term results in these cases.

Upper eyelid hollowness is a dramatically underappreciated, yet incredibly important component of aging in the eyelids. With normal aging, our upper eyelid fat pads tend to retract and expose this upper lid hollowness, those with “deep set eyes“ are especially prone, and unfortunately old-school upper eyelid surgery that is overly subtractive can artificially create this hollowness early, actually looking worse than it did before surgery - the before and after photo in the link below resulted from overly subtractive upper eyelid surgery with another surgeon, and you can see the results after revolumization of the upper lids. Correcting this hollowness can happen with filler injections into very specific planes of the upper eyelid, or transposing and rearranging the upper eyelid fat pads to provide fullness, as you see in this surgeon’s view video, borrowing the excess fat to move into the areas lacking fullness!


To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.


Cameron Chesnut
#realself100 Physician

Thank you for sharing your question. The permanent method for improving your hollowed eyes is with fat grafts. Dermal fillers work well too. The fat is permanent, but has a much higher complication rate. The fillers will last between 6-12 months. Find an experienced surgeon who specializes in eyelid surgery and the handling of complex cases. Good luck.

Classic upper blepharoplasty can produce hollow upper eyelid, resulting in an older appearance.  In my practice I routinely do revision upper blepharoplasty for this condition.  It requires very specific technique, including structural fat graft, supratarsal crease defenition, laser resurfacing, etc.  Seek out a talented and experienced surgeon for an in person evaluation.

Typically we see this effect in the lower potions of the eye.Please feel free and send me photos and I will be more than happy to give more advice once I see exactly what you are talking about.

Fat Grafting can provide a beautiful, lasting and natural results to hollows in the upper eyelid. When expertly performed, fat grafting will provide a natural, but dramatic result that can make a person look more youthful and vibrant. Before and after images of fat grafting can be found on Realself and on the websites of most plastic surgeons. By viewing photos and watching videos, you can learn about the technique a plastic surgeon uses with fat grafting and the results he or she is able to achieve.  After you find many photos that are appealing to you, carefully check the background, safety record, training and experience of any plastic surgeon you are considering. Be sure to find a plastic surgeon who will not overfill with fat. And, find a plastic surgeon who really listens to you and understands your goals. 

Artistically performed micro-fat grafts are the best permanent solution. Conservative injections with hyaluronic acid fillers like Restylane can produce an improved temporary correction in many patients.I would suggest that you find a surgeon with extensive  experience certified by the American Board of Plastic Surgery and
one who is ideally a member of The American Society for Aesthetic Plastic
Surgery (ASAPS) that you trust
and are comfortable with. You should discuss your concerns with that surgeon in
person.

Additional information about the procedure will
help you decide if it is a procedure that you want to pursue.
Robert Singer, MD FACS

La Jolla,California

I'm very sorry to hear that you are not happy with the appearance of your upper eyelids after having a cosmetic blepharoplasty.  Hollowness in the upper eyelids following blepharoplasty surgery is usually seen in people who have bone structure with eyes that are deeper set, or if too much tissue was removed during the surgery.  The best way to correct this issue is with careful injection of a thin, hyaluronic acid-based facial filler to add more volume to the area beneath the brow.  I only use Restylane or Restylane Silk for these injections and it is best to take a conservative approach as swelling can be very common in this area following such injections.  I would caution you against having any permanent or thicker filler material injected into this area as such products can frequently produce an unnatural lumpiness that is very difficult to treat.  Make sure that you see an Oculoplastic surgeon or another experienced facial injector who is comfortable treating this specific area of the face.Best, Dr. Gregory Lewen